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PO Box 7709 Bend, OR 97708-7709 www.lifewiseor.com MEMBER ENROLLMENT AND CHANGE APPLICATION For groups with 51 or more employees 1. GROUP INFORMATION (to be completed by the group) Group name Enrollment

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What is enrollment or change form?

Enrollment or change form is a document that individuals or organizations fill out to enroll or make changes in their existing information in a system or program.

Who is required to file enrollment or change form?

Any individual or organization who needs to enroll or update their information in a system or program is required to file an enrollment or change form.

How to fill out enrollment or change form?

To fill out an enrollment or change form, you need to provide the requested information accurately and completely as per the guidelines provided. The form may be available in electronic or paper format.

What is the purpose of enrollment or change form?

The purpose of an enrollment or change form is to gather necessary information from individuals or organizations who wish to enroll in a system or program or make changes to their existing information.

What information must be reported on enrollment or change form?

The information required to be reported on an enrollment or change form may vary depending on the specific system or program. Generally, it includes personal or organizational details, contact information, identification numbers, and any relevant supporting documentation.

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